Medicinal plants used in the treatment of maternal health-related problems by the Mapulana of Ehlanzeni District, Mpumalanga province, South Africa

Study area

The study was conducted in 15 villages in the Ehlanzeni District (Fig. 1) within three local municipalities, namely, Bushbuckridge, Mbombela, and Thaba Chweu. The Ehlanzeni district is among the three district municipalities located in the north-eastern part of Mpumalanga Province of South Africa.

Data collection

Structured questions were asked during interviews of participants selected for the study. The snowball technique was used whereby participants referred others for inclusion in the study (Cohen et al., 2007). The interviews were conducted face-to-face with selected elderly people, community adults, and youths. The interviews sought information on the names of various plants used to treat some common maternal-health problems, plant parts used, administration route, the traditional names for these ailments, and whether any ailments required combinations of plants. All participants signed prior consent forms as a show of willingness to participate in the study. Voucher specimens were collected for each plant species mentioned during the interviews were identified, labeled, and deposited in the University of Venda, Department of Botany’s Herbarium. The researcher obtained ethical approval from the University of Venda Research Ethics Committee registered as project number SMNS/17/BOT/01/0905.

Data analysis

Thirty-eight participants were selected for the study and they were able to list various plants used for maternal-healthcare. A frequency index was calculated using a mathematical formula adapted from Madikizela et al. (2012). The formula FI = FC/N × 100 states that FI is the frequency index, which expresses the percentage of frequency of listing a plant species by participants. FC is the number of participants who listed the use of a certain plant species and N is the total number of participants.

Demography of informants

Responses of participants are represented in Table 1, whereby community adults, were more knowledgeable about plants used for maternal care, followed by the elders. Fifteen percent of the overall participants were traditional health practitioner (THP). Overall, female participants responded well as compared to males, presumably because females are the recipient of maternal-healthcare. Most of the participants had at least attended secondary schools.

Figure 1. Showing map of Ehlanzeni local municipalities. [Click here to view]

Plant species used for the treatment of maternal healthcare problems

Thirty-two plant families with 49 genera used for maternal healthcare problems were recorded in the study (Table 2). Fabaceae was the most frequently cited family, followed by Apocynaceae, Asphodelaceae, and Rutaceae. Similar finding was observed by Steenkamp (2003); Mahwasane et al. (2013); Kankara et al. (2015); Yazbek et al. (2016). de Wet and Ngubane (2014) and Nduche et al. (2015) in their studies recorded Euphorbiaceae as the most cited families.

Plant parts frequently used in the current study were roots followed by bulbs, leaves, bark, and whole plant (Fig. 2). Similar finding was observed by Steenkamp (2003) and Mahwasane et al. (2013) where roots were the most used parts; however, Shosan et al. (2012); Nduche et al. (2015), and Kankara et al. (2015) reported leaves as the most frequently used parts, in their studies.

The frequently cited plant species were Annona senegalensis subsp. senegalensis and Senna occidentalis with 26% and 18% frequency index, respectively. Mahwasane et al. (2013) observed similar finding where A. senegalensis subsp. senegalensis had the highest frequency index in a study done among the Vhavenda of Lwamondo village in Limpopo Province of South Africa.

Table 1. Demographic structure of participants. [Click here to view]

Decoctions were prepared and taken orally for almost all the plants mentioned in the study. Preparation of decoction was also highlighted by Abdillahi and Van Staden (2013) and Kankara et al. (2015). The mode of administration for all the plants as indicated in Table 3 depends on the instructions given by the THP or Herbalist and the nature or state of the problem (Mabogo, 1990; Steenkamp, 2003). For the treatment of conception problems, hematuria, and dysmenorrhea, mothers were usually required to drink half a cup, three times a day for 3 to 7 days of the decoction depending on the level of the problem. Babies were given oral medicine in small quantities, two to three times a day depending on their age. In the case of sunken or bulging fontanelles, the medication can be given in baby formula from day 1 of birth to 12 months of age or more if required or depending on the closure levels of the fontanelles. Typhoid treatment is rather unpleasant for children, since fresh leaves are crushed to make a paste which is inserted through the anus, however; oral mode is hence preferred.

Some plants are combined to increase the chances of healing; it is argued that all the plants species work synergistically.

Roots dominate in terms of being the plant parts utilized most for maternal healthcare purposes among the Mapulana. This is not a sound practice since it may affect the vigor of such plants thereby killing them. The death of individual plants ultimately affects the viability of the population in the long run and hence may lead to the demise of the species. Mapulana people avoid this by only harvesting the required roots from few trees or shrubs (Kurui et al., 2016).

Figure 2. Plant part used for maternal healthcare. [Click here to view]

Table 2. Inventory of medicinal plants used in treatment of maternal health care in the Ehlanzeni District municipality. [Click here to view]

Table 3. Administration of medicinal plants used in treatment of maternal health related symptoms in Ehlanzeni District municipality. [Click here to view]

Local conditions treated by Mapulana

Phogwana

The term Phogwana represents sunken or bulging fontanelles which are usually called “soft spots” on the infants’ head; the treatment is over the first 12 months of the baby’s life. The process is called “cleansing period” (Bland et al., 2004). Fontanelles or ukhakhanyi, inyoni (as called by Zulu-speaking people), are perceived as an open entrance for evil spirits, hence warranting immediate treatment (Cocks and Moller, 2002). Mapulana infants are treated with traditional medicine for sunken and bulging fontanelles. The study identified 13 plant species that treat the ailment—Hypoxis hemerocallidea, S. occidentalis, Annona senegalensis subsp. senegalensis, Lantana rugosa, Clematis brachiate, Gomphocarpus fruticosus subsp. fruticosus, Diospyros mespiliformis, Ansellia Africana, Leonotis ocymifolia, Euclea crispa var. crispa, Flueggea virosa, Gymnosporia senegalensis, Sida acuta, and Lippia javanica. Within these plants species, there are combinations used for the treatment as indicated in Table 4. Our findings supported that of Mabogo (1990) who identified the use of A. senegalensis subsp. senegalensis in the treatment of fontanelles among the Vhavenda people. Persia americana was one of the species recorded by Shosan et al. (2012) to treat fontanelles in Nigeria, while Abdillahi and Van Staden (2013) recorded Ormocarpum trichocarpum as a treatment for fontanelles in some parts of South Africa.

The sunken and bulging fontanelles cleansing purposes in infants include when they have diarrhea. Diospyros mespiliformis was reported as treating diarrhea in Lwamondo (Mahwasane et al., 2013); similar finding includes using G. senegalensis for treating diarrhea by de Wet and Ngubane (2014) and Vuuren et al. (2015) which also quantifies the cleansing period, since some of the species used for sunken and bulging fontanelles are also used to minimize diarrhea.

Table 4. Combination of medicinal plants species used for maternal health care. [Click here to view]

Lenogane

The term Lenogane refers to the weak intestine as a result of an internal wound not healing after the baby’s umbilical cord was removed. Treatment of abdominal pains (colic) in infants including stomach sounds is referred to as inkaba in Zulu (Bland et al., 2004). Allium sativum, S. occidentalis, and Fallopia convolvulus are the only species recorded for treating colic. Healing of wound is also supported by food supplement prepared with Bauhinia galpinii (Mabogo, 1990). The food supplement can in turn also facilitate relief from constipation. In Botswana, E. crispa var. crispa was reported to relieve constipation (Chinsamy and Koitsiwe, 2016). Masafu et al. (2016) in their comparative studies of medicinal plants used in Thulamela and JS Moroka Municipalities of South Africa reported that H. hemerocallidea was used in the treatment of constipation and intestinal parasites. They also reported the use of Mewilla plumbea in the treatment of colic. Tephrosia purpurea subsp. purpurea is a treatment for internal wounds for women in Benue State, Nigeria (Awai and Igoli, 2015). Moteetee and Van Wyk (2011) recorded Equisetum ramosissimum and Acacia karroo as the treatment for colic in Lesotho. Masafu et al. (2016) recorded M. plumbea being used as the treatment for colic from a study of the natural habitats and the uses of medicinal plants in Thulamela and JS Moroka Municipalities. Allium sativum was recorded in Abeokuta South Local Government Area of Ogun State, Nigeria, as one of the species treating abdominal cramps (Shosan et al., 2012).

Motlhapo

Mohlapo is a term used when women have blood in their urine (hematuria). The plant species identified from the study were Erythrina lysistemon and Hypoxis rigidula var. rigidula.

Metjhwa

When babies frequently want to feed or are constantly licking their nails, the ailment is called Metjha (nail-biting). Acacia karroo and Abrus precatorius subsp. africanus are the two species identified as being used for the treatment of the condition by the Mapulana.

Ditshemane or Manogane or Nkusu

Ditshemane or Manogane or Nkusu is the local name referring to typhoid among the Mapulana. The treatment is applicable to children of all ages. Leaves of Prunus persica var. persica and Lycopersicon esculentum are used as in combination to treat typhoid. Other combinations are shown in Table 4. Shosan et al. (2012) recorded four species for treating typhoid, including Mangifera indica and Sorghum bicolor.

Selomi

Selomi is when women experience severe period pains (dysmenorrhea) and some of the women are unable to conceive as a result. It is perceived that most women with Selomi have “tied-up wombs.” The participants also argued that the tying of the womb can also be spiritually connected. Dysmenorrhea is treated with Cyperus latifolius and Piliostigma thonningii. In a study conducted in Lwamondo by Mahwasane et al. (2013), P. thonningii and D. mespiliformis were reported as being used in the treatment of stomach problems. The treatment of dysmenorrhea traditionally was recorded from numerous studies. Steenkamp (2003), Mahwasane et al. (2013), and de Wet and Ngubane (2014) have recorded many plant species used for the treatment of dysmenorrhea. Senna occidentalis and E. crispa var. crispa were also identified in the treatment of dysmenorrhea by Mabogo (1990), Steenkamp (2003) and Moteetee and Van Wyk (2011).

Aloe zebrine, Castanospermum australe, B. galpinii, and Conostomium natalense var. natalense are recorded species for the treatment of conception difficulties. Awai and Igoli (2015) recorded 10 plant species for the treatment of conception in Benue State, Nigeria, including A. senegalensis subsp. senegalensis, Carica papaya, and S. occidentalis. Masafu et al. (2016) reported that H. hemerocallidea was used in the treatment of infertility. From the current study, Grewia flavescens and Cassia abbreviata plant species were reported to “untie women’s wombs”. Rhamnus mucronata, Casearia gladiiformis, and Scolopia stolzii were also reported for treatment of conception difficulties in Dabaga Ulongambi Forest Reserve, Tanzania (Kitula, 2007).

Makgoma

Makgoma is a term used to describe the results of people’s negligence of their tradition. The consequences include swollen stomach or body parts (legs and hands), coughing, and a shiny appearance. In this study, the researcher’s concentration with the issue was in relation to infants and pregnant women. In the case of pregnant women, they can be affected by Makgomo if they do not follow all the rules in their tradition. Certain rules, such as pregnant women being restricted from having sexual relations when there is a funeral in their families; they are expected to wait for 7 days of cleansing before any intimacy. In addition, if a woman has an illicit relationship and then cooks for people at her family funeral, whoever eats the food will become “contaminated” “o kgomisiwe”. Sclerocarya birrea subsp. caffra, Ximenia caffra var. caffra, Persea americana, Siphonochilus aethiopicus, and Citrus sinensis were the recorded species used to treat Makgoma in women. Nduche et al. (2015) recorded S. acuta subsp. acuta as arresting a threatened miscarriage. Bauhinia petersiana was recorded as preventing miscarriage in Mulanje District, Malawi (Maliwichi-Nyirenda and Maliwichi, 2010). Abdillahi and Van Staden (2013) have recorded Sasevieria hycacinthoides and Pyrenacantha scandens in the prevention of miscarriage in South Africa. Anyi-Ndenye women of Eastern Cote d’Ivoire have several plant species used to prevent miscarriages within the three trimesters of pregnancy. Some of the species recorded for this use were Desmodium adscendens, Ficus exasperate, and Cyanthyla prostrate (Malan and Neuba, 2011).

Sclerocarya birrea subsp. caffra is used to support pregnancy (Mabogo, 1990) and prenatal care (Kankara et al., 2015; Randrianarivony et al., 2016). Siphonochilus aethiopicus is used to protect homesteads (Masafu et al., 2016). People living around the Analavelona forest in South West Madagascar use a combination of three to ten plant species for protecting women and babies from evil spirits. Plant species used are Sida cordifolia, Flacourtia ramontchi, and Grewia flavascens to mention a few (Randrianarivony et al., 2016). Similar results were observed by Cocks and Moller (2002) where women bought plant medicines for the protection of their infants.

Difeka

Difeka is connected with Makgoma, whereby women’s negligence might cause the baby to be instantly disabled or disabled after 20 months of birth and turn into an infant. This can be caused by the negligence of tradition by ignoring the generic protocol. For instance, if a third-born woman has intercourse on a firstborn pregnant woman‘s bed, when the pregnant woman later uses the bed “o fikegele” might occur, that is the pregnant woman may deliver a disabled child. In the case of a woman who had lost a baby and commits “di fikeka” this might result in that woman not conceiving or death. Agapanthus africanus and C. papaya were reported as remedying difeka. Agapanthus africanus subsp. africanus is taken for prolonged labor ( Abdillahi and Van Staden, 2013; Kaido et al., 1997; Steenkamp, 2003), and C. papaya induce lactation (Randrianarivony et al., 2016).